Characterization of a feminizing testicular leydig cell tumor by hormonal profile, immunocytochemistry, and tissue culture

Abstract

A patient with gynecomastia and a nonpalpable testicular Leydig cell tumor is presented. Estradiol and progesterone levels were elevated whereas serum testosterone was reduced. Following removal of the tumor the hormonal values returned to normal with reduction of gynecomastia. Tumor tissue was maintained in culture for 9 days during which high estradiol levels as well as lesser quantities of testosterone and progesterone were demonstrated in the culture medium. Elevation of progesterone supports a block of 17 alpha-hydroxylase activity caused by increased endogenous estradiol. This is the first case of a cultured feminizing testicular Leydig cell tumor in which hormone production was demonstrated. The freshly removed tumor as well as the cultured tissue material were studied by immunocytochemical methods and biochemical analysis of cytoskeletal proteins. These methods revealed vimentin as the exclusive type intermediate sized filament in both. This is the first demonstration of vimentin in a Leydig cell tumor, in agreement with its occurrence in normal Leydig cells.

TGF-β and epithelial-to-mesenchymal transitions

“…Vimentin expression has been suggested as a critical marker to distinguish 'true, complete EMT' from 'cell scattering' or 'partial EMT' (Janda et al, 2002a;Grunert et al, 2003). However, vimentin expression is not specific for fibroblastoid cells, as it is also present in leukocytes, endothelial cells, and in some carcinomas without signs of dedifferentiation or EMT (Czernobilsky et al, 1985;Auersperg et al, 1994). These observations confound the use of vimentin as EMT marker in vivo, in particular in conditions that are associated with tissue inflammation.…”

Case 12-2000

“…20 Nonpalpable tumors have been detected by ultrasonography, selective venous sampling, or both. [21][22][23][24]36,37 In 10 percent of cases, Leydig-cell tumors metastasize. 20 No single pathological finding distinguishes benign from malignant Leydig-cell tumors, but re-cent analyses of 30 cases 38 and 20 cases, 39 as well as a previous large study performed at this hospital, 20 indicate that individual tumors can be assigned to favorable and unfavorable prognostic groups on the basis of several clinical and pathological factors.…”

Die Hypothalamus-Hypophysen-Gonaden-Achse bei Patienten mit benignen Leydig-Zelltumoren: Eine Langzeitstudie

“…In unserer Serie hatten zum Diagnosezeitpunkt zwei Patienten pathologisch erhöhte E2-Spiegel, bei weiteren zwei Patienten war E2 im oberen Normbereich gelegen. Physiologischerweise erfolgte bei Männern ungefähr 25 % der Östradiolproduktion in den Leydig-Zellen [10,13]. Daraus resultierend führen Tumoren, welche ihren Ursprung in diesen Zwischenzellen haben, häufig zu einer E2-Überproduktion.…”

“…Als dritter Mechanismus kommt ein direkt hemmender Einfluss des E2 auf die Leydig-Zellen infrage [13,18,19]. E2 hemmt die 17a-Hydroxylase und die 17b-Hydroxysteroid-Dehydrogenase.…”